High blood pressure, a silent killer

Be cautious if you use sleeping pills regularly, as a new study has found that it may impact blood pressure (BP) in older adults.

High blood pressure has always been described as a silent killer by the medical profession because the disease can exist without a single symptom for a very long time. Sadly, the only time people are made aware of their hypertension is when they get a stroke or heart attack, by which time, it is too late to do anything to save the patient.

It is very rare for someone with even severe raised blood pressure to present with symptoms due to high blood pressure. Headache, with raised blood pressure is rare. Quite frequently, high blood pressure is only diagnosed on routine examination. Many patients or people live with notion that they can tell when their pressure is up.  This is a dangerous misconception that must be completely destroyed in the minds of the lay public.

High blood pressure can exist for many years without a single obvious symptom to warrant medical attention. As the pressure goes up, it can slowly damage the kidneys, the heart muscle and the lining of the blood vessels. Unfortunately, if blood pressure is not regularly monitored and controlled with proper medication, it can result in severe irreversible costly complications like heart failure, heart attack, stroke and kidney failure.

I discovered much of the ignorance by patients on high blood pressure is largely due to a failure by health practitioners for not stressing the importance of patients to check their blood pressure regularly and for not telling them enough times that hypertension does not usually have symptoms. I had one elderly gentleman, who was told without any investigations that he had kidney failure and high blood pressure.

He innocently informed me that he skips his blood pressure medication for months and only uses it when he does not feel well. It came as a shock to him and to many of you reading this article that high blood pressure may not have any symptoms at all. His blood pressure was 180/120 which put him at a very high risk of getting a major complication.

It also turned out that he was grieving about the loss of his son, who died at a young age from a stroke, after he learnt that his wife wanted to leave him. The gentleman was worried that he too ran the risk of getting a stroke like his son did, if he didn’t seek help. We really don’t know why people acquire high blood pressure except for a few medical conditions. Of late, many young people in their mid twenties are being diagnosed with hypertension without any identifiable or treatable cause.

Stress, lack of exercise, poor or insufficient sleep  poor eating habits and high salt intake all play a role in contributing to the high incidence of hypertension amongst young adults. I have come across patients, who have been on several antihypertensive agents and who were doing very stressed jobs at work.
Shortly after these patients retired or changed jobs, their blood pressures came down considerably, requiring very little medications, proving the point that perpetual stress can have an adverse effect on one’s health and well being.

In this patient’s case, he needed counselling and treatment for his depression in order to control his blood pressure, apart from his usual anti hypertension medication. The constant worrying could have led to him having a heart attack. I have also noticed that patents’ blood pressures can change within a period of six months. That is why, it is so important for a practitioner to always check the patient’s blood pressure at every visit.

One reading of high blood pressure is insufficient to make a diagnosis of hypertension. It should be repeated after five or ten minutes and if not too high, the blood pressure should be reviewed after a week to make absolutely certain about the diagnosis. Quite often blood pressure medications are prescribed routinely, without reviewing whether a patient needs  medication.

If the blood pressure is fairly low on treatment, 110/70 for example, it might be an idea to cut one of the medications and review the response. This approach cuts costs and minimises side effects. I have come across patients, who stopped using medications for over three months off their own accord . On checking their blood pressure, I have discovered that their blood pressure was perfectly normal, so l stopped their medication with the advice for them to have their blood pressure checked every six months to be on the safe side.

My worst experiences were two females who completely ignored their blood pressure for years in spite of being warned of the dangers of skipping treatment. The one patient, in her mid forties, was rushed into my rooms, after a  three year absence, in a severe coma  with a blood pressure of 300/200. She had a major hemorrhage in the brain and died on her way to hospital.

The second patient presented with severe heart failure with a blood pressure of 240/160 whilst on treatment for years. Her blood pressure was never well controlled because she was extremely non-adherent when it came to taking her medicines or having her blood pressure  checked. She was admitted and successfully managed but she now has chronic kidney disease. She will eventually need renal dialysis in the not too distant future but she still remains very not adherent to her treatment.

Many blood pressure medications have intolerable side effects which forces patients to stop using them. Patients should inform their doctor so that the right medication to suit the patient can be prescribed. Some tablets can cause severe cough, swelling of feet, erectile dysfunction in men and rarely, severe mood swings and anxiety. This should be mentioned to the doctor but do not make the mistake of stopping medications without using something more suitable.

Treating hypertension every day with one tablet is a lot easier than to live with a stroke and end up up depressed and unemployed in the prime of one’s life. Cold and flu must be be  avoided in patients with hypertension. People with hypertension must be careful never to use flu preparations with ephedrine or pseudo ephedrine in them because they can push up one’s blood pressure. Energy drinks with high caffeine content must also be avoided.

The digital home blood pressure machines are not always accurate, so be careful not to rely on them too much. Patients often make the mistake of requesting repeat medication without wanting to be examined. A doctor has to check the blood pressure reading to make sure that the medications are achieving the desired level. Once in six months is usually adequate.

The ideal blood pressure is 120/80. Treatment is commenced once a  person has a blood pressure of 140/90 on more than two occasions. People with diabetes and pregnant females with hypertension have monitor their blood pressure regularly to ensure that a target of 120/80 is always achieved to prevent complications. So, don’t let the silent killer get the better of you, now that you have been made aware of it.

Dr Ellapen Rapiti is a family physician, specialising in child and mental health and addiction counselling.